MR. Edward B Lack, MD

NPI #1417955584 in Brandon, Florida

Provider Information

NPI Number: 1417955584
Entity Type: Individual
Name: MR. Edward B Lack, MD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dermatology
Credential: MD
Enumeration Date: Jul 12, 2005
Last Updated: Nov 15, 2016

Practice Location

Address: 540 MEDICAL OAKS AVE
Address 2: SUITE 102
City: Brandon
State: Florida
ZIP Code: 33511-5995
Phone: (813) 651-1991

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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